Provider Demographics
NPI:1366335366
Name:ALI, EEDA SHAMMO
Entity type:Individual
Prefix:
First Name:EEDA
Middle Name:SHAMMO
Last Name:ALI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9018 FORT ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-1749
Mailing Address - Country:US
Mailing Address - Phone:402-808-0899
Mailing Address - Fax:
Practice Address - Street 1:3830 F ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-3551
Practice Address - Country:US
Practice Address - Phone:402-613-6766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide